Amend the bill, as and if amended, page 525, after line 7, by
adding a new Part appropriately numbered to read:

/PART __

PERMANENT PROVISIONS

SECTION 1

TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING
SECTION 44-6-75 SO AS TO PROVIDE THAT FROM JANUARY 1, 2014
THROUGH DECEMBER 31, 2016, MEDICAID ELIGIBILITY IS EXPANDED
PURSUANT TO THE PATIENT PROTECTION AND
AFFORDABLE CARE ACT TO INCLUDE INDIVIDUALS AGE NINETEEN THROUGH
AGE SIXTY-FOUR AND FAMILIES WITH INCOME AT OR BELOW ONE HUNDRED
THIRTY-THREE PERCENT OF THE FEDERAL POVERTY LEVEL; BY ADDING
SECTION 44-6-78 SO AS TO ESTABLISH THE 'CONTINGENCY FUND FOR
CONTINUED CARE' FOR CONTINUATION OF MEDICAID EXPANSION BEYOND
2016, IF AUTHORIZED BY THE GENERAL ASSEMBLY, WITH FUNDS FROM
HEALTH CARE SAVINGS REALIZED FROM PROGRAMS OF THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES, PREVENTIVE SERVICES PROVIDED PURSUANT
TO THE ACA, AND STATE TAX REVENUE GENERATED BY THE FEDERAL FUNDS
RECEIVED FOR MEDICAID EXPANSION; AND TO PROVIDE THAT THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES SHALL MAKE ALL MEDICAID
AUTHORIZATIONS NECESSARY TO CARRY OUT THIS SECTION, PROVIDED
THAT THE FEDERAL GOVERNMENT FUNDS ONE HUNDRED PERCENT OF THE
COST OF SERVICES RENDERED FOR NEWLY ELIGIBLE MEDICAID EXPANSION
BENEFICIARIES.

A. Whereas, the Patient Protection And Affordable Care Act of
2010 (ACA), as amended, provides for the expansion of the
Medicaid program to cover adults age nineteen through sixty-four
and families that have income at or below one hundred and
thirty-three percent of the federal poverty level (FPL), which
includes a five percent income disregard, equating to income at
or below one hundred thirty-eight percent of the FPL; and

Whereas, the ACA stipulates that from
January 1, 2014 through December 31, 2016, the federal
government will fund one hundred percent of a state's cost of
Medicaid services provided to newly eligible beneficiaries under
the expansion; and

Whereas, the latest data from the Milliman
study prepared for the South Carolina Department of Health and
Human Services estimates that approximately 351,000 South
Carolinians would become newly eligible for Medicaid under the
expansion; and

Whereas, according to the Milliman study
(April, 2012), opting to participate in the Medicaid expansion
for 2014-2016 results in an estimated $4.1 billion in new
federal funding, which includes only half of the funding for
2014, and an estimated $81 million in administrative costs,
which includes some cost elements that would exist even if South
Carolina did not adopt the expansion, resulting in a net benefit
to the State of approximately $4 billion; and

Whereas, based on data from the Milliman
Study (April, 2012) it is estimated that more than $236 million
in state tax revenue would be generated during 2014-2016, with
only the second half of 2014 included in the estimate, from the
expansion funds and the resultant job growth, both within and
outside the health care industry, income gains, and additional
purchasing, which replaces, almost three-fold, the $81 million
projected to be expended by the state in administrative costs to
implement the expansion; and

Whereas, an additional requirement of the
ACA provides that beginning in 2014 and continuing through 2020
reimbursement of federal Medicaid and Medicare Disproportionate
Hospital Share funds will be reduced whether or not a state opts
to participate in the Medicaid expansion; the amount of federal
funds the State is projected to lose from this reduction is $2.6
billion for the years 2014 through 2020; however, if the state
participates in Medicaid Expansion, these losses would be
substantially offset by the federal expansion funds coming into
the state; and

Whereas, as South
Carolinians have begun to understand Medicaid expansion and its
ramifications, a constantly growing number of organizations have
voiced their strong support for the expansion; one of the most
recent proponents is the Charleston Metro Chamber of Commerce,
with eighteen hundred plus members, which has embraced the
expansion due to the reduction in healthcare costs for
businesses and the commensurate growth and expansion of
business, industry, and jobs; the South Carolina Small Business
Chamber of Commerce, which for the past decade has tried to
address its members' top priority, 'the cost of health
insurance', vociferously endorses Medicaid expansion and the
reduction in or elimination of health insurance premiums, a
substantial savings for its members; AARP found that fifty-four
percent of older adults in the State support Medicaid expansion,
even though many of them already receive Medicare and would not
directly benefit; the South Carolina Hospital Association, the
South Carolina Primary Care Association, the American Heart
Association, and United Way all have recognized that not only
will many of their members and patients directly benefit from
Medicaid expansion, but also that the expansion will help with a
more efficient and effective use of our health care resources;
and in addition, print and visual media across the state promote
the value of Medicaid expansion for the State, its residents and
businesses, and the overall health and productivity of the
State; and

Whereas, not only does opting into Medicaid
expansion significantly impact and improve the state's economic
welfare, but exercising this option also gives hundreds of
thousands of South Carolinians the opportunity to improve their
individual health and their chances of entering and maintaining
a place in the workforce as a contributing, productive member of
their communities and the State. Now, therefore,

B. The Department of Health and Human Services shall make all
Medicaid authorizations required to implement the Medicaid
expansion provided for in this Section; however, implementation
of this Section is dependent upon the federal government
providing one hundred percent of the Medicaid funding necessary
for expansion in accordance with the Patient Protection and
Affordable Care Act, P.L. 111-148 of 2010, as amended by the
Health Care and Education Reconciliation Act, P.L. 111-152 of
2010.

C. Article 1, Chapter 6, Title 44 of the 1976 Code is amended by
adding:

"Section 44-6-75.
Beginning January 1, 2014, through December 31, 2016, the
following are eligible for Medicaid pursuant to the provisions
of the Patient Protection and Affordable Care Act, P.L. 111-148
of 2010, as amended by the Health Care and Education
Reconciliation Act, P. L. 111-152, of 2010:
(1)
a family with income at or below one hundred thirty-three
percent of the federal poverty level, which includes a five
percent income disregard; and
(2)
a childless individual nineteen through sixty-four years
of age with income at or below one hundred thirty-three percent
of the federal poverty level, which includes a five percent
income disregard.

Section 44-6-78. (A)
There is created the Contingency Fund for
Continued Care in the Office of the State Treasurer, a fund
separate and distinct from the general fund of the state for the
purpose of preserving funds for the continuation of Medicaid
Expansion provided for in Section 44-6-75 if authorized by the
General Assembly pursuant to subsection (D). The following
must be deposited into this fund:
(1) health care
savings generated from programs, policies, and procedures of the
Department of Health and Human Services newly implemented or
expanded as an alternative to Medicaid expansion during 2014
through 2016;
(2) savings realized
from preventive services provided to newly eligible Medicaid
beneficiaries pursuant to the Medicaid expansion during 2014
through 2016:
(3) notwithstanding
any other provision of law providing for the disposition of any
tax or fee, net state tax revenue generated from implementation
of the Medicaid expansion and the commensurate growth in jobs
and increased income and purchasing.
(B)(1) To determine the
funds to be deposited in the Contingency Fund for Continued Care
pursuant to items (1) and (2) of subsection
(A), the State Budget and Control Board, Research and Statistics
Division, shall work in conjunction with the Department of
Health and Human Services and in consultation with the South
Carolina Primary Care Association and the South Carolina
Hospital Association and shall submit their findings to the
State Budget and Control Board.
(2)
The Department of Revenue shall determine the funds to be
deposited in the Contingency Fund for Continued Care pursuant
to item (3) of subsection (A) and shall submit its findings to
the Budget and Control Board.
(C) The State Budget
and Control Board shall certify to the State Treasurer the
transfer of funds pursuant to this Section to the Contingency
Fund for Continued Care.
(D) The General
Assembly may authorize the continued participation of the State
in Medicaid Expansion, in accordance with the provisions of the
Patient Protection and Affordable Care Act, if the General
Assembly finds that Medicaid Expansion, as provided for in
Section 44-6-75, has substantially achieved its goals of
providing Medicaid to newly eligible beneficiaries and
generating health care savings and state tax revenue."/